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Many people think of psoriasis as just a skin disease. Sure, it may be
itchy and uncomfortable. But how bad could living with psoriasis really
be?

Yet while psoriasis symptoms may be on the skin, psoriasis is no superficial
condition. Psoriasis can have a devastating effect on every aspect of a
person's life. It can affect your relationships, your sense of self, your
romantic life, your job, and your finances.

Despite all the suffering, too many people living with psoriasis aren't
getting help. "There are lots of patients out there who have just given up
and stopped seeking treatment," says Robert Brodell, MD, a dermatologist at
Northeastern Ohio Universities College of Medicine. They're muddling
through alone.

And even people in treatment may find that the emotional impact of psoriasis
gets overlooked. "I think that the majority of dermatologists still
don't talk about the very serious psychosocial issues related to
psoriasis," says Alan Menter, MD, president of the International Psoriasis
Council. With psoriasis, focusing on the skin alone may not be
enough.

What do you need to know about the emotional effect of living with
psoriasis? And how can you deal with it? Here are some answers.

Stigma of Psoriasis

Research shows the huge impact that psoriasis can have. Experts cite studies
that track the quality of life of people with various illnesses.
"Psychologically, the only disease that debilitates people more than
psoriasis is depression," says Mark Lebwohl, MD, chairman of the medical
board of the National Psoriasis Foundation. Psoriasis has a more profound and
more negative effect on person's well-being than every other disease --
including diabetes and cancer.

So why does psoriasis have such a huge impact? For many living with
psoriasis, it's the stigma -- how other people react to you, and how that makes
you feel.

Stigma can quickly cause those living with psoriasis to change their
behavior. As other people start to notice their skin, they become more
self-conscious and anxious. They start covering-up their psoriasis and making
excuses for it. They opt out of social situations. Severe stigma can alter a
person's whole personality, changing a confident, outgoing person into someone
ashamed and withdrawn.

If psoriasis symptoms worsen, the person pulls back even more. It's a
snowballing effect that puts people with psoriasis at higher risk of other
problems, like anxiety and depression.

"Depression is a very serious issue for people with psoriasis,"
Menter tells WebMD. One study showed that 25% of people with psoriasis are also
depressed. One out of ten people living with psoriasis has thought about
suicide.

Of course, most people living with psoriasis don't become clinically
depressed. But even mild cases can result in chronic stress. Menter says that
people who are between flares or who only have minor symptoms still live with a
basic anxiety: what if it gets worse?

All that psoriasis stress doesn't only affect your emotional health. Stress
is also a well-established trigger for flares.

"Stress makes the psoriasis worse, and the psoriasis makes the stress
worse," says Brodell. "You get into a vicious cycle."

The Stress of Psoriasis Treatment

In addition to the stigma of psoriasis, a sometimes forgotten cause of
stress is treatment itself. Psoriasis treatment can be demanding. Many
treatments require a lot of commitment.

"Having a disease like psoriasis is a lot of work," says Phillip
Mease, MD, a Seattle rheumatologist who specializes in treating psoriatic
arthritis. "You have to arrange for all these doctor visits and treatments,
to advocate for yourself with insurance companies. It's almost like having a
part-time job."

There is good news: new biologic medicines have transformed treatment.
"We now have the medicines that can clear most psoriasis patients in just
10 to 12 weeks," says Menter.

But the medicines are expensive. Treatment with biologic medicines can range
from $14,000 to $28,000 a year, says Brodell. The price can force people living
with psoriasis to make tough decisions.

"Some people basically have a choice between getting treatment or
selling their houses," Brodell tells WebMD.

And even if you're not using these cutting-edge medicines, psoriasis
treatments can still cost you. Phototherapy might last months or even a year.
Not only will you have to pay for weekly treatments, but you might have trouble
fitting them into your work schedule.

Tips for Living With Psoriasis

Considering the serious effects of psoriasis, what can you do to stay
emotionally healthy while living with psoriasis?

Stay connected. Psoriasis is a condition that can pull you away from
others. Don't let that happen. You need the support of the people you trust and
care about right now. So even when you're feeling down or self-conscious, try
to push through it. Also, consider joining a support group for people coping
with psoriasis -- the National Psoriasis Foundation sponsors them throughout
the country.

Find a doctor you trust. Choosing the right doctor might not seem
relevant to your emotional state, but it is. If you have confidence in your
doctor, you'll probably be more confident in your treatment. That can give you
a more optimistic view in general. A good doctor can also advise you on issues
beyond the medical. For instance, if you're having trouble affording treatment,
your doctor might be able to get you in touch with pharmaceutical programs that
give away medicine for free. Or he or she might tide you over with free
samples.

However, if you feel like your doctor is ignoring your concerns -- or just
handing you tubes of cream that never help -- think about seeing someone else.
Find a dermatologist who is a psoriasis expert and who knows about all the
treatment options.

See a therapist. Many people living with psoriasis seek out
therapists. Will therapy solve everything? Will it prevent you from feeling
humiliated if a stranger keeps staring at the plaques on your arms? No. But it
can help you learn better ways to cope with the social situations that you'll
encounter. See if your dermatologist has any recommendations for a therapist
who has experience treating people with psoriasis and similar conditions.

Of course, if you feel like anxiety is getting in the way of your life, or that
you might be depressed, you need to get help right away. Depression isn't
inevitable for people living with psoriasis. Therapy -- and sometimes
medicine -- will help.

Living With Psoriasis: the Benefits of Treatment

Obviously, you don't want a doctor who only considers your skin and isn't
interested in the emotional impact of living with psoriasis. But there is a
flip side -- sometimes, the best way to resolve the emotional problems caused
by psoriasis is to control the disease itself.

"It's been well shown in studies," says Menter. "As you improve
the psoriasis symptoms with treatment, you see simultaneous improvements in
their emotional state, stress, depression, fatigue, the health of their
relationships, their sexual health, and their functionality at work. It's
paralleled almost week by week."

So never ignore the emotional suffering caused by psoriasis -- get help. But
by the same token, don't ignore the underlying disease either. No matter how
severe your case, no matter how many failed attempts you've made before, there
are very good treatments out there.

"The first thing I tell people with psoriasis is you don't have to
live with your disease," says Menter. "We have the tools to help
you now."